Vertical vs Horizontal Health

Programs
Department of Global Health and Policy
ACIPH
October 22, 2022
 Learning objectives
• By the end of the course the student will be
able:
– Describe vertical and horizontal health programs
– Understand the advantages and disadvantages of
the two approaches
– Understand the factors to be considered in developing
countries in choosing mode of delivery of health services

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 Vertical vs Horizontal Programs
• Health program planners face the question of how they
can most effectively and efficiently provide health
services.
• Health services can be provided using two modes of
delivery: horizontal and vertical.
• Health programs at the beginning of modern public
health were provided vertically.
• At the launch of the ‘Health for All by 2000’, the
strategy to attain the set goals was a comprehensive
PHC based on a horizontal mode of delivery of
basic services (WHO 1978).
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Vertical vs Horizontal Programs cont’d

• A few years after implementation of PHC:

– Difficult to attain the set goals, e.g. failure to control
malaria,
– There was increase in incidence and prevalence of TB,
– Emergence of drug resistance TB and
– Emergence of HIV/AIDS.

• Consideration in changing strategy; selectivity and

prioritization of interventions, particularly in
resource limited settings.

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 Vertical Programs
• Vertical delivery of health services implies a
selective targeting of specific interventions not
fully integrated in health systems (disease specific,
categorical, standalone).

• Vertical programs can operate parallel to other

programs:
– May have their own management, staff, financing and
procurement arrangements
– In some situation it might even have its own facilities

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 Vertical Programs cont’d
Advantages
– They show quick results
– Easier to manage than horizontal programs
– Effective in reaching the target group
– Easier to monitor
– Useful when the overall health system is
extremely weak
– Attractive to donors
– If the intervention is short duration

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 Vertical Programs cont’d

Disadvantages
– Very demanding on resources of public service
– Diverting human and financial resources from
already resource-constrained health systems
(e.g. “National Immunization Days, NIDs”)
– Sustainability of vertical programs in terms of
outcomes and resources is always questionable
– Fading political commitment

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 Vertical Programs cont’d
Examples of vertical programs in our country?

• HIV, leprosy and malaria control programs were

managed as classical vertical program
– Has centrally located administrative and operational
activities
– Has minimum/absent integration with the general health
system

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 Horizontal Programs

By horizontal delivery: services are delivered

through public financed health systems and are
commonly referred as comprehensive primary
care.

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 Horizontal Programs cont’d
Examples:

• Routine immunization: In most countries, EPI

services are fully integrated into health systems.
• Family health

• Blindness control program

• Cervical screening & treatment

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 Horizontal Programs cont’d
Advantages
– When services are fully integrated into health
systems, programs can be sustained
– Are attractive to policy makers because of their
long-term sustainability
– Important for services which require
comprehensive coverage
– Where there is a sound infrastructure and
functional health systems, it works well
– Cost effective

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 Horizontal Programs cont’d
Disadvantages
– Work well in a context of sound infrastructure
and functional health systems and work poorly
otherwise
– Not easily managed as vertical program
– An integrated ‘horizontal’ system may not be as
effective as a vertical program in monitoring
compliance to treatment and serious side
effects

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 What are the issues to be
considered?

Factors to be considered in developing countries in

choosing mode of delivery of health services:
– Seriousness of a problem
– Geographical demands of health services
– The nature of population to be served
– The nature of the service
– Available resources (human and financial)
– Sustainability of programs
– Analysis of costs and benefits
– Donors interest
– Program duration
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